Scaling up antiretroviral therapy in developing countries: what are the benefits and challenges?

In recent years the case for antiretroviral therapy (ART) in those countries hardest hit by the HIV pandemic is seldom contested. Prior to the widespread availability of antiretroviral therapy in many developing countries, there were however frequent concerns expressed about the safety and feasibility of promoting widespread access to ART in countries such as those in Southern Africa. These concerns were premised on the potential “anarchy” that might be the result of weak health systems leading to widespread virological resistance,1,2 on the grounds that there were more cost-effective interventions available given the limited funding baskets at the time,3 and on the potential to do more harm than good if introducing large and complex new interventions into already weak and fragmented health systems, further increasing inequities.4,5 The first public-sector ART treatment programmes in developing countries (with the exception of Brazil) date back to 2000,6 and data are now emerging on the effectiveness of the interventions.